Factor 8 Activity in a Hemophiliac Patient with Acute Lymphocytic Leukemia

We have treated a 21 year old white male with classic hemophilia A for acute lymphoblastic leukemia. At presentation the patient had a white blood count of 30,000 with 90 per cent lymphocytes. Bone marrow asperate revealed 80 per cent blasts which were periodic acid-schiff positive and peroxidose negative. Remission was induced with a course of methotrexate, vincristine and prednisone. Factor 8 activity was measured by the method of kaolin activated partial thromboplastin time using congenitally deficient plasma at presentation and while in remission. Factor 8 activity was less than one per cent at presentation and the same while in complete remission. At no time during the course of the disease did the measured factor 8 level spontaneously rise above one per cent concentration. Bleeds felt to be typical of hemophilia occurred at occasional intervals during the patients two year course of treatment. These did not appear to occur with any less frequency than prior to the onset of the acute leukemia. These findings are in contrast to previously published reports of increased factor 8 levels during the uncontrolled phase of acute lymphocytic leukemia.